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Individual

BETHANY STULL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LMP

Contact information

Practice address
1310 S UNION AVE, STE A-202, TACOMA, WA 98405-1907
(253) 507-4631
Mailing address
3320 SW 320TH ST APT 25, FEDERAL WAY, WA 98023-2260
(253) 797-6336

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA 60622268
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
47-1101118
LMP
WA
Enumeration date
02/09/2017
Last updated
02/09/2017
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